Penetrating orbital injury with organic foreign bodies.

OBJECTIVE: The authors reviewed the clinical features, diagnostic workup, and management of patients of penetrating orbital injuries with retained organic foreign bodies. DESIGN: Retrospective, noncomparative case series. PARTICIPANTS: Nineteen patients (15 males, 4 females) with penetrating orbital injuries due to organic foreign bodies. RESULTS: The series included 15 (78.9%) males and 4 (21.1%) females who ranged in age from 6 months to 40 years (mean = 14.6 years); 12 (63.2%) patients were younger than 12 years of age. Twelve (63.2%) right and 7 (36.8%) left orbits were involved. Time between injury and presentation varied from a few hours to 9 months. Most common injury site was the superior orbit in 11 (57.9%) patients leading to abnormal extraocular motility (84.2%), proptosis (68.4%), and upper lid ptosis (47.4%). Associated pathologies also included acute cellulitis in 11, orbitocutaneous fistula in 5, and osteomyelitis in 2 patients. Preoperative computed tomography (CT) and magnetic resonance imaging (MRI) identified the foreign bodies in 42% and 57% of the patients, respectively. CONCLUSION: Preoperative identification of the foreign material in the orbit was found to be very helpful for patient management but was only possible in approximately 50% of our cases with the use of CT and MRI. The vision in our patients usually improved shortly after treatment; the long-term complications more often included extraocular muscle and eyelid motility problems and periorbital scarring.

Cystic basal cell carcinoma of the orbit and eyelids.

When basal cell carcinoma develops cystic change, its clinical and radiological features vary, leading to confusion in differential diagnosis We report four cases with cystic formation of 62 patients with orbital and adnexal basal cell carcinoma encountered during the last 12 years. The salient clinical, radiological, and histopathological features of these cases are presented and differential diagnosis of large cystic lesions in the orbit is discussed. When the basal cell carcinoma develops cystic changes it mimics other orbital cysts, including inclusion cysts due to penetrating injury, mucoceles, and necrotic metastatic tumors.

Thrombophilia in ethnic Arabs in Kuwait.

One hundred and thirty unrelated patients with recurrent deep venous thrombosis were studied over a period of 4 years (1986-1990) in order to determine the possible etiology. Protein C levels were estimated in plasma both by chromogenic substrate assay and by immunoassay. Protein S levels in plasma was determined by immunoassay using antisera to human protein S. Antithrombin III (AT-III) was assayed using monospecific rabbit antiserum to human AT-III. Fifteen patients were found to have hereditary protein C deficiency (11.52%). Family studies revealed autosomal recessive inheritance in one patient and a dominant pattern in the remaining 14 patients. Protein S deficiency was found in eight cases (6.1%), AT-III deficiency was established in five cases (3.8%) and a fibrinolytic defect in 33 cases (25.4%). Thrombosis of visceral and cerebral vessels and a positive family history were more frequently found among patients who had hereditary deficiency of one or the other antithrombotic factor. Thrombophlebitis of superficial veins was found to be very common in patients with protein C and protein S deficiency and virtually absent in AT-III deficiency. The high frequency of protein C and protein S deficiency in this ethnic group is attributed to the high frequency of consanguinity.

Retroscleral-intraconal RTV silicone implants: an alternative technique for volume replacement post-extruding eviscerated spherical implants.

Two patients with extruded implants postevisceration were assessed and managed with room temperature vulcanized (RTV) silicone implants placed in the retroscleral-intraconal space. The technique described is an alternative and simple surgical method that provides utilization of the remaining sclera, anterior support for the implant, and adequate volume replacement. The postoperative follow-up is relatively short, and clinical and radiologic (CT scan) investigations support the efficacy of the procedure. To the best of our knowledge, such a surgical alternative has not been reported.

Silastic intubation in congenital nasolacrimal duct obstruction: a study of 129 eyes.

Congenital nasolacrimal duct (NLD) obstruction, the most common cause of congenital epiphora, occurs in approximately 5% of newborns. Before the advent of canaliculodacryo intubation, management of most cases of partial lacrimal obstruction that failed conservative management and probing necessitated bypass surgery such as dacryocystorhinostomy. Noninvasive closed system lacrimal intubation improved the success rate and provided a non-surgical therapeutic alternative. We present 129 eyes with congenital NLD obstruction managed with silastic lacrimal intubations. Early management is recommended with a minimum of 7 months' retention of the stents. Statistical assessment of results and management of complications is presented.